| NPI | 1710196100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD430555) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ 25MA08606300) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2015-03-26 |